By Laura Szondy

As of June 2013, the American Medical

Association recognized obesity as a
disease that requires medical treatment.
Nutrition Examination survey 2009-2010,
prevalence of obesity in the United States
is 35.5% in adult men, 35.8% in adult
women, including 4.4% and 8.2%
respectively with BMI >40 kg/m2.
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

A dietary prescription based on individual
energy expenditure is the first step for
obesity prevention and treatment.
Resting energy expenditure contributes
from 50-75% of total energy expenditure,
depending on the physical activity level.
Therefore, the assessment of REE
provides useful information for weight
management.
* Agreement between Different Methods and Predictive Equations for REE
Study aimed to evaluate the agreement between
methods and equations for REE estimation for
overweight and obese.

REE measured by indirect calorimetry, MSJ,
WHO/FAO/UNU, Fleisch, Horie-Waitzberg and
Gonzalez, and Ireton-Jones.

Found Mifflin, Horie-Waitzberg and Gonzalez,
and Fleisch most appropriate to estimate needs.
* Agreement between Different Methods and Predictive Equations for REE

Primary aim of study was to compare different
methods for assessing energy expenditure in
overweight and obese.

Assessed indirect calorimetry, respiratory quotient, and
predictive equations: MSJ and Harris-Benedict.

Conclusion: Using indirect calorimetry or Harris-
Benedict equation to assess REE in an older,
overweight/obese population is more reliable and
accurate than using RQ.
Found MSJ estimate was less accurate than the Harris-Benedict
when compared to IC.
* Comparison of Energy Assessment Methods in Overweight Individuals
Objective to analyze which REE predictive
equation was the best alternative to IC.

27 predictive equations were assessed.

Found for US overweight and obese class
I and II adults can best be predicted with
the Mifflin equation, with almost 80%
accuracy for US adults.
* Validity of Predictive Equations for REE in US and Dutch Overweight and Obese Class I and II adults
Recommendation: In the critically ill
obese patient, if indirect calorimetry is
unavailable, energy requirements should
be based on the Penn State University
2010 predictive equation or the modified
Penn State University equation if the
patient is over the age of 60 years (strong).
ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity
Recommendation: In the hospitalized
obese patient, if indirect calorimetry is
unavailable and the Penn State University
equation cannot be used, energy
requirements may be based on the Mifflin-
St Jeor equation using actual body weight
(moderate).
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

Rationale: Critically ill patients with BMI
>45 kg/m2, accuracy of the PSU equation
was highest at 76% compared to others
studied.
In older critically ill obese patient with BMI
>30 kg/m2, a modified PSU appears to be
more accurate than the original PSU, with
accuracy of 70%.
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

Younger Obese Patients:
RMR = MSJ(0.96)+ Tmax (167)+ VE(31) 6212

Older Obese Patients:
RMR = MSJ (0.71) + Tmax (85) + VE (64) 3085

Where MSJ = Mifflin-St Jeor equation, VE =
minute venitlation (L/minute), Tmax = maximum
temperature in prior 24 hours in degrees C



* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

Recommendation: Clinical outcomes are at
least equivalent in patients supported with
high protein hypocaloric feeding to those
supported with high protein eucaloric feeding.
Suggested in patients who do not have
severe renal or hepatic dysfunction.

Feedings started at 50-70% of estimated
needs or <14 kcal/kg actual weight. High
protein started with 1.2 g/kg actual weight or
2-2.5 g/kg IBW.
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

Rationale: Insulin resistance, glucose
intolerance, hyperlipidemia, nonalcoholic
fatty liver disease, and hypoventilation
syndrome are more prevalent in patients
with obesity than non-obese. The
hospitalized patient with obesity is
susceptible to experiencing complications
with overfeeding, hence why hypocaloric,
high protein regimens have been designed
by clinicians.
* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

Rationale: In the critically ill, ventilator-
dependent obese patient, PSU equation
most accurately predicts compared to
others including: Harris-Benedict, Mifflin-St
Jeor, Swinamer, and Ireton-Jones, with
highest prediction accuracy of 70% and
lowest likelihood of over or under
estimation.

* ASPEN Nutrition Support of Hospitalized Adult Patients with Obesity

1. Choban, P. , Dickerson, R., Malone, A., Worthington, P., Compher,
C. A.S.P.E.N. Clinical Guidelines Nutrition Support of Hospitalized
Adult Patients with Obesity. JPEN, 2014.

2. Esteves de Oliveria, F., Alves, R., Zuconi, C., Riberio, A.
Agreement Between Different Methods and Predictive Equations
for Resting Energy Expenditure in Overweight and Obese Brazilian
Men. Journal of The Academy of Nutrition and Dietetics.
September 2012. Volume 112, Number 9.

3. Anderson, E., Sylvia, L., Lynch, M., Sonnenberg, L., Lee, H.,
Nathan, D. Comparison of Energy Assessment Methods in
Overweight Individuals. Journal of The Academy of Nutrition and
Dietetics. February 2014. Volume 114, Number 2.

4. Weijs, P. Validity of Predictive Equations for REE in US and Dutch
Overweight and Obese Class I and II Adults Aged 18-65 y. The
American Journal of Clinical Nutrition. 2008, 88:959-70.